| Doctor Name: | REBECCA A NICHOLS/O'BERRY |
| NPI Number: | 1013985597 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 4224 |
| Business Practice Address: | 210 Simmons St Maryville, TN - 37801 |
| Business Phone Number: | 8659709800 |
| Business Fax Number: | 8653801461 |
| Mailing Address: | Po Box 1999, LOUISVILLE |
| State: | TN |
| Postal Code: | 37777 |
| Phone Number: | 8659701295 |
| Fax Number: | 8653801461 |
| NPI Enumeration Date: | 03/09/2006 |
| NPI Last Update Date: | 12/23/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 4224 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |